10 Years of PMSMA: Achievements, Maternal Health Impact & Challenges in India

On 9 June 2026, the Ministry of Health launched a campaign marking 10 years of Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA).

• The scheme was launched in 2016 to improve maternal healthcare and reduce maternal deaths.

Important Terms

• Maternal Mortality Ratio (MMR): Maternal Mortality Ratio refers to the number of maternal deaths occurring during pregnancy, childbirth, or within the post-pregnancy period per 1 lakh live births. 
  • India’s MMR has improved significantly, declining from 130 deaths per 1 lakh live births earlier to 87 deaths per 1 lakh live births currently. 
  • The Sustainable Development Goal (SDG) 2030 target aims to reduce MMR to below 70 deaths per 1 lakh live births.
• Antenatal Care (ANC): Medical care and check-ups provided to women during pregnancy before childbirth.
• Institutional Delivery: Delivery conducted in hospitals/health facilities instead of homes.
• Out-of-Pocket Expenditure (OOPE)
  • Direct healthcare spending from the patient’s own pocket.
  • Insurance-covered expenses are not counted as OOPE.

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Reasons Behind the Success of PMSMA

• 9th of Every Month Strategy: Under the 9th of Every Month Strategy, pregnant women are provided free antenatal check-ups at government health facilities on the 9th day of every month. The initiative mainly focuses on women in the second and third trimesters of pregnancy. A fixed date has improved awareness, attendance, and regular tracking of pregnant women.
• Comprehensive Care Package (Single Window System): Earlier, pregnant women had to visit different places for consultations, tests, medicines, and other services. PMSMA introduced a single-window approach, where women receive all essential services at one place, including:
  • Doctor consultation
  • Blood and urine tests
  • Ultrasound examination
  • Free medicines
  • Counselling services
  • Delivery preparation guidance
• Participation of Private Doctors: The government launched the “I Pledge for 9” campaign to involve private healthcare professionals. Under this initiative, private specialists provide free services at least 12 days every year at government health facilities. This helped address the shortage of specialists and strengthened maternal healthcare delivery.

Innovative Feature: High-Risk Pregnancy Identification

During pregnancy, doctors screen for around 25 risk factors, such as:

• Anaemia
• Gestational diabetes
• Pregnancy-induced hypertension

Women are identified using colour-coded stickers:

Benefits

• Healthcare workers can immediately identify high-risk mothers.
• Ensures specialised monitoring.

Extended PMSMA (2022)

The Extended Pradhan Mantri Surakshit Matritva Abhiyan (Extended PMSMA) was launched in 2022 to bridge the gap between monthly check-ups and provide continuous monitoring of high-risk pregnancies.

Three Pillars of Extended PMSMA

Dedicated Follow-up Tracking

• Special antenatal care visits are planned for red-sticker (high-risk) pregnant women.
• These women receive up to four additional ANC sessions until delivery.
• It ensures continuous monitoring and timely medical intervention.

Name-Based Listing

• High-risk pregnant women are registered through government portals and records.
• This helps in tracking each beneficiary and prevents women from being left out of the healthcare system.

Financial Incentives

• High-risk mothers receive ₹100 per additional follow-up visit (up to a maximum of three visits) to support travel and related expenses.
• ASHA workers are provided incentives for tracking and supporting high-risk mothers.
• An additional ₹500 reward is given to ASHA workers if both mother and child remain healthy up to 45 days after delivery.

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Supporting Schemes

• Janani Suraksha Yojana (JSY): The scheme provides cash incentives to promote institutional deliveries and encourage women to deliver in healthcare facilities.
  • It has benefited around 11.96 crore women.
• Janani Shishu Suraksha Karyakram (JSSK): The scheme aims to reduce the financial burden on pregnant women by providing free maternity and newborn care services, including:
  • Free medicines
  • Free diagnostic tests
  • Free food during hospital stay
  • Free transport facilities
• SUMAN (Surakshit Matritva Aashwasan)
  • Ensures zero tolerance against denial of maternity services.
  • It guarantees free and respectful maternal healthcare services at public health facilities.
• Pradhan Mantri Matru Vandana Yojana (PMMVY)
  • Provides financial assistance to compensate for wage loss during pregnancy.
  • Encourages women, especially from vulnerable sections, to take adequate rest and access institutional healthcare.
• LaQshya Initiative: Focuses on improving the quality of labour rooms and maternity operation theatres.
  • Aims to ensure:
    • Safe deliveries
    • Better infection prevention
    • Improved maternal and newborn outcomes

Achievements of PMSMA and Related Maternal Health Initiatives

• Around 7.5 crore women have received free and quality antenatal care services.
• India’s Maternal Mortality Ratio (MMR) declined from 130 to 87 deaths per 1 lakh live births.
• High-risk pregnancies are being identified at an early stage, helping prevent maternal and child deaths.
• Maternal healthcare services have been expanded through:
  • Ayushman Arogya Mandirs
  • District Hospitals
  • First Referral Units (FRUs)

Challenges

• Regional Inequality
  • Maternal healthcare outcomes vary significantly across states.
  • States like Kerala and Tamil Nadu have achieved lower MMR due to better healthcare infrastructure and access.
  • States like Uttar Pradesh, Madhya Pradesh, and Assam continue to face higher maternal mortality challenges.
• Shortage of Specialists: Rural healthcare facilities often face a shortage of trained specialists, including:
  • Gynaecologists
  • Paediatricians
  • Anaesthetists
• Limitation of Monthly Check-ups: Although monthly antenatal visits improve monitoring, complications may develop between two scheduled visits.
  • High-risk pregnancies require more frequent and continuous monitoring.
• Last-Mile Connectivity Issues: Delayed ambulance services and poor transport facilities in remote areas affect timely access to emergency maternal care.
  • Delay in reaching hospitals can increase the risk of maternal deaths.
• Low Awareness: Social customs, misconceptions, and lack of awareness often delay healthcare seeking behaviour among pregnant women.
  • This reduces timely registration and antenatal care utilisation.

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Way Forward

• Strengthen digital health platforms for real-time tracking of pregnant women, especially high-risk pregnancies.
• Develop cloud-based health records to ensure continuous monitoring and better coordination among healthcare providers.
• Train ASHA workers to identify risk factors at the community level and ensure timely referrals.
• Increase availability of specialists in rural health centres and strengthen emergency obstetric care.
• Develop GPS-enabled ambulance networks for faster transportation during maternal emergencies.
• Promote institutional deliveries through awareness campaigns and community participation to reduce preventable maternal deaths.

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